CulturallySensitiveMaternaland NewbornCareProgram: AddressingBarrierstoHealthServices AccessforMangyanWomen

Dr.NoelEspallardo EmikoMasaki

The views expressed in this paper are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data in this paper and accepts no responsibility for any consequence of their use. The countries listed in this paper do not implay any view on ADB's part as to sovereignty or independent status or necessarily conform to ADB's terminology.

MalingIsoy

InJune2006,shewas Uponarrival,theoperation admittedtoinaprimary wasdoneninehourslaterin carefacilityinMansalayfor thehospital. childbirth. Duetobloodloss,shedied Animmediatecaesarean inrecoveryroomafew sectionwasneededdueto hourslater.Shewas complications.Shewas approximately40yearsold transferredthenextdaytoa whenshedied. hospitalinCalapancityby Jeepneyfor46hoursof journey.

BarrierstoAccessingHealthServices
Supplyside Geographicfactors,such asdistance Availabilityofservices Demandside Financialfactors Socioeconomicfactors Culturalfactors

CulturalBarrierstoHealthServices
Traditionalcultural beliefsareconsideredas barriers Ethnicwomenaremade toadapttothesystem Utilizationofhealth servicesisgenerallylow amongethnicminorities

TA6143REG

PromotingGenderEqualityand WomensEmpowerment
(PHI:IndigenousPeopleCommunityMaternal andNewbornCareProgramSubproject)

OrientalMindoro
In2008statistics
totalpopulation744,573 Annualgrowthrateof1.8% crudebirthratewas22.1per 1,000 crudedeathratewas4.0per 100,000

TheMangyans
Mangyanisthegeneralnameforthe indigenouspeoplesfoundinMindoro totalpopulationmaybearound 100,000 ethnicgroupsare: Iraya Alangan Tadyawan Tawbuid Buhid Hanunoo.

ProjectObjectives
Developmentofculturallysensitivematernaland newbornhealthcareservices ImprovedutilizationofRHUmaternaland newbornhealthcareservices Installedmechanismsforsustainability

KeyActivityArea(1)
EthnographicStudies andSurveys Developmentof Culturallysensitive MaternalandNewborn CareProgram TrainingandRetraining ofHealthWorkers

KeyActivityArea(2)
TrainingofMangyanhealthworker volunteers BehaviourChangeCommunications

KeyActivityArea(3)
ImplementationandMonitoring InstallingMechanismsfor Sustainability

GeneralStepsinProgram Implementation

ResultsofEthnographicStudy

ResultsofEthnographicStudy

HealthWorkers Attitudeand Perception

Peaceloving,hospitable,humble andgoodnaturedpeople Takeagreementsseriouslyand usuallyreportduringagreed meetings Theyusuallysticktothehealth workerassignedtothemand wouldhesitatereceivingservices fromothers

TagalogPatients Attitudesand Perception

DescribeMangyasasuntidy andsmelly ThedistancefrommostMangyan communitiestohealthfacilitiesis averyimportantbarriertothe utilizationofhealthcenter services Mangyansshouldbeattendedto firstinhealthcenterservices

ImplicationofRapidEthnographic StudyFindings
Culturalbeliefsandpracticeshouldnotbeconsideredas barrier SocialpreparationforMangyanstorecognizethebenefitsof RHUbasedmaternalandnewbornservicesshouldbedone TheRHUstaffmustallowahusbandassisteddeliveryinthe facility Healthworkersmustbetrainedonculturesensitive communicationskills TrainingofMangyanhealthvolunteersmustbepartofthe program TheRHUmaydevelopvariationsofhealthservicesdesigned foraparticularculturalbeliefofpatientsi.e.Mangyansor Tagalogs.

GeneralStepsinProgram Implementation

ComponentsofCMNCProgram
Appropriatefacilitiesmannedbytrained andculturesensitivehealthworkers Equitable,evidencebasedandculture adaptedmaternalandnewbornhealth interventionsandservices Behaviourchangecommunicationsto encouragehealthserviceutilization

GeneralStepsinProgram Implementation

CulturesensitiveWorkforce
Mixedcultureworkforce Mangyanculturalbrokermay benecessary Mangyanhealthvolunteers

LEARN
Listen tothepatientsperspective. Explain yourownperspective.Makesureyouspeakthelocal dialect. Acknowledge thedifferencesandsimilarities.Dontcriticize norargueagainstthebelief.Emphasizeacommonobjective. Recommend atreatmentplanaftersettingacommon objective. Negotiate foramutuallyagreedtreatmentplan.

TrainingWorkshops
MHOandNurses Nov2224,2009 Midwives Nov2527,2009 MangyanHealthVolunteers Dec810,2009 NursesandMidwivesRetraining Feb1617,2010 Trainingofhospitalpersonnel May2728,2010 Trainingonadolescentcounselling Aug2527,2010

GeneralStepsinProgram Implementation

BalayMangyan(TraditionalBirthingFacility)
MedicalequipmentandsuppliessupporttoBEMONC BalayMangyan(MangyanHouse)

GeneralStepsinProgram Implementation

CommunityOutreachVisits
Communityoutreachvisitsmustbedesignedtoprovidepre natalcaretoasmanypregnantpatientsandasmany frequenciesaspossible

EducationalMaterials

GeneralStepsinProgram Implementation

ResultsoftheProgram
Impact Reducedmaternaland neonatalmortality Outcomes (withtargets) Increasedutilization
22facilitybased deliveries 3CEMONCdeliveries Zone North Central South Total Zone North Central South Total Number 0/0 0/2 0/0 0/2 Number 29 38 40 117

ResultsoftheProgram
Increasedcapacityofhealthcareproviders
Zone North Central South Total Baseline 8.70 8.29 8.84 8.63 Shortterm 9.78 9.29 10.58 9.90 6months 10.07 9.88 10.04 9.90 12months 8.78 8.54 9.86 8.93

ResultsoftheProgram
Satisfactiontohealthservices 95%of105Mangyanwomenwhorespondedtothe surveybelievethatgivingbirthinthehealthcenteris goodforthemotherandchild
Zone North Central South Satisfactionto HealthService 4.62 4.81 4.05 AwarenessLevelof Mangyans 6.00 7.27 6.42

Thankyou